Tyler de Lara, 2, thrashes on a gurney, tangled in his sheet, hospital gown and IV tubing. A white bandage encircles his head and, loosened by his squirming, slips down and covers his eyes.
All that shows is a tuft of black hair and his mouth, set in an angry pout.
Dr. Akira Ishiyama notes Tyler's grimace and says he's pleased. It means there is no facial nerve damage.
Tyler was diagnosed as deaf six months earlier. Now, on an autumn morning at UCLA's outpatient surgery center -- after several misdiagnoses, battles with insurance companies and much worry and waiting -- he is drifting from a cloud of anesthesia with two cochlear implants nestled in his skull.
His parents, Michael and Marieta, hope he can finally enter the world of those who speak and hear.
One or two of every 1,000 U.S. children are born profoundly deaf, numbers that have not changed for decades. What is changing -- at an unprecedented pace -- is the number of those children under 3 who are receiving cochlear implants, electronic devices that mimic the function of delicate cells of the inner ear.
About 40% of such children now receive a cochlear implant, up from about 25% five years ago. Medicaid and most private insurers will pay for at least one implant, and the number of deaf children who receive one or even two is projected to rise still further.
Cochlear implants have long been endorsed for adults. But studies published in the last two years have delivered what many experts say is ironclad evidence that the devices are safe in babies and toddlers and allow most children to develop spoken language without extensive occupational therapy.
"It used to be a big decision, a big, bold move," says Efrat A. Schorr, a developmental psychologist at the University of Maryland. "It's not anymore. It's become the standard of care for children with profound hearing loss."
Before implants, deaf children learned American Sign Language or lip reading. Most fared exceedingly well, although many could not speak. Like the De Laras, however, many families whose children receive implants today are dissuaded from learning sign language, a trend that will bear repercussions for the entire deaf community and that some experts fear is a mistake.
Tyler's generation, hearing experts say, will redefine what it means to be deaf.
"I describe it as a revolution," Schorr says. "It's close to a miracle, what this technology has made possible."
